Abnormal bone scintigraphy and acute-onset severe primary hyperparathyroidism

Abstract

Acute-onset primary hyperparathyroidism in a previously asymptomatic individual is uncommon. We herein report the case of a 61-yr old woman who underwent bone scintigraphy for severe, rapidly worsening, diffuse bone pain, associated with weight loss, anxiety and confusion. The patient was asymptomatic until a few days before presentation. A marked redistribution of the tracer was observed, with poor bone uptake and relevant accumulation in liver, kidneys, lungs and spleen. Blood chemistry unequivocally allowed the diagnosis of primary hyperparathyroidism due to multiple parathyroid adenomas, as suggested by parathyroid scan. Unfortunately, the patient critically worsened and surgery was made impossible. She died despite intensive critical care. Autopsy confirmed both massive intraparenchymal calcium deposition in the kidneys, lungs, liver and spleen, as well as multiple parathyroid adenomas. One may speculate that some adaptation of the organism to progressively increasing blood calcium levels and to slowly increasing intraparenchymal calcium salt deposition occurred, until critically high concentrations were attained.

Heterotopic ossification in patients previously hospitalized in an intensive care unit

“…Nuclear medicine plays an important role in the imaging of several pathological conditions in young and adult patients. Bone scan (BS) is such a study, performed for whole body bone evaluation for various reasons, including HO [8,9]. The three-phase bone scan (3pBS) in HO patients exhibits increased radionuclide uptake in affected areas and increased vascularity that could precede or follow the formation of the heterotopic bone formation [7].…”